PONE-D-22-00205Economic Impact of a Machine Learning-Based Strategy for Preparation of Blood Products in Brain Tumor SurgeryPLOS ONE

Dear Dr. Tunthanathip,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

==============================

ACADEMIC EDITOR:Please revise the manuscript in line with the reviewers' comments.

==============================

Please submit your revised manuscript by May 19 2022 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Venkatesh Shankar Madhugiri

Academic Editor

PLOS ONE

Journal Requirements:

When submitting your revision, we need you to address these additional requirements.

1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at

https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf  and

https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf

2. Please include your tables as part of your main manuscript and remove the individual files. Please note that supplementary tables (should remain/ be uploaded) as separate "supporting information" files.’

3. Please include your full ethics statement in the ‘Methods’ section of your manuscript file. In your statement, please include the full name of the IRB or ethics committee who approved or waived your study, as well as whether or not you obtained informed written or verbal consent. If consent was waived for your study, please include this information in your statement as well.

4. Thank you for stating the following financial disclosure:

“The Faculty of Medicine, Prince of Songkla University. (Grant no. 64-477-10-1)”

Please state what role the funders took in the study.  If the funders had no role, please state: "The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript."

If this statement is not correct you must amend it as needed.

Please include this amended Role of Funder statement in your cover letter; we will change the online submission form on your behalf.

5. In your Data Availability statement, you have not specified where the minimal data set underlying the results described in your manuscript can be found. PLOS defines a study's minimal data set as the underlying data used to reach the conclusions drawn in the manuscript and any additional data required to replicate the reported study findings in their entirety. All PLOS journals require that the minimal data set be made fully available. For more information about our data policy, please see http://journals.plos.org/plosone/s/data-availability.

Upon re-submitting your revised manuscript, please upload your study’s minimal underlying data set as either Supporting Information files or to a stable, public repository and include the relevant URLs, DOIs, or accession numbers within your revised cover letter. For a list of acceptable repositories, please see http://journals.plos.org/plosone/s/data-availability#loc-recommended-repositories. Any potentially identifying patient information must be fully anonymized.

Important: If there are ethical or legal restrictions to sharing your data publicly, please explain these restrictions in detail. Please see our guidelines for more information on what we consider unacceptable restrictions to publicly sharing data: http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions. Note that it is not acceptable for the authors to be the sole named individuals responsible for ensuring data access.

We will update your Data Availability statement to reflect the information you provide in your cover letter.

Additional Editor Comments (if provided):

Please see reviewers comments and address the issues raised by them.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Partly

Reviewer #2: Yes

**********

2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

**********

3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

**********

4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

**********

5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Economic Impact of a Machine Learning-Based Strategy for Preparation of Blood Products in Brain Tumor Surgery

The main objective of this study was to identify the cost differences of the ML-based strategy compared with other strategies in preoperative blood products preparation.

For the reader it is hardly possible to compare the strategies. No lab parameters could be found as well as no evidence-based strategies. Therefore, the different strategies must be discussed in more detail.

In some university hospitals it is allowed to take back packed red blood cells (pRBC) from the ward to the blood bank (established quality management system). This is not allowed in the US, but in Europe. Maybe you can talk with the responsible persons in your hospital. This must not be considered here.

ML is the strategy of choice and should be introduced wherever it is possible. Does it work also in catastrophes (Blackout)? Perhaps you can prepare another paper to answer this question.

Here some hints:

Introduction

References 2, 3 of blood transfusion in neurosurgery in Thailand with limited meaningfulness. See for example:

Curr Opin Anaesthesiol. 2014 Oct; 27(5): 470–473. doi: 10.1097/ACO.0000000000000109

McGirr, A, Pavenski, K, Sharma, B, Cusimano, M. Blood conservation in neurosurgery: erythropoietin and autologous donation. Can J Neurol Sci. 2014;41(5):583-589.

Meybohm, P., Fischer, D.P., Geisen, C. et al. Safety and effectiveness of a Patient Blood Management (PBM) program in surgical patients - the study design for a multi-centre prospective epidemiologic non-inferiority trial. BMC Health Serv Res 14, 576 (2014). https://doi.org/10.1186/s12913-014-0576-3

Goebel, BJA Patient blood management in intracranial neurosurgery—do we have sufficient data to define a transfusion threshold? Comment on Br J Anaesth 2018; 120: 988-98

No reference is given although it is used as supplementary data

Please, make an update of the literature

Guidelines

Reference 18, 19 are no guidelines, but clinical trials.

Clinical Neurology and Neurosurgery, Volume 155, April 2017, Pages 83-89: Evidence-based outcomes for transfusion thresholds and indications are limited.

Please, discuss the advantages and limits of your references in respect of missing guidelines.

Costs

$3,0061.56, $57,313.92, and $136,292.94

Please, correct the error and use US-$. How did you calculate the costs? Since the prices of packed red blood cells are very different in different countries, I recommend giving percentages with reference to one of the basic methods.

Conclusions are too general

The pandemic has caused a reduction in blood donation activity. Maybe this is true in Thailand, but not in other countries due to different rules to live with the pandemics.

This general conclusion is not valid. It is an assumption, but not shown with data. It seems that partly the opposite is the case.

ML-based strategy offers a way to calculate preoperative crossmatch and effectively reduce the cost of unnecessary blood products preparation via a web application.

Cross match does not mean that the pRBC are on the ward and either transfused or lost if not needed. As long as the pRBC are in the refrigerater on ward or stil in the blood depot of the blood bank the pRBC can be used also for other patients.

Please, formulate more precisely.

Reviewer #2: In these retrospective study the authors aimed to analyzed patient who received surgery from January 2014 and December 2021. Through the analysis of multiple preoperative parameters that may affect the RBC transfusion volume, they used ML algorithms to build up the artificial intelligence (AI) model to predict the accurate RBC demand quantity and compared each result with those predicted by clinicians and to evaluate the economic impact. Their results were shown that the ML methods is more accurate than clinician experience in predicting preoperative RBC transfusion, which reduce the unnecessary cost of blood preparation.

This seems a promising study, can be accepted

**********

6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

Economic Impact of a Machine Learning-Based Strategy for Preparation of Blood Products in Brain Tumor Surgery

PONE-D-22-00205R1

Dear Dr. Tunthanathip

We are pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you will receive an e-mail detailing the required amendments. When these have been addressed, you will receive a formal acceptance letter and your manuscript will be scheduled for publication.

An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org.

If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Venkatesh Shankar Madhugiri

Academic Editor

PLOS ONE